IMO is one of the few ophthalmological centres in Spain to pioneer the use of groundbreaking 3D surgical technology, which is currently undergoing significant development, as they first incorporated it within their operating theatres in 2015. “Three-dimensional digital visualisation has advanced considerably in this short period and the Institute’s vitreoretinal specialists have completed approximately 200 operations using the novel technology, transcending the learning curve required to adapt to a new way of operating on our patients”, explains Dr José García-Arumí.
The technique involves two high dynamic range (HDR) cameras that “look” through the microscope and send the images to a processing unit, thereby converting the conventional optical viewing system into a digital one. The images captured are projected on a monitor as wide-field, high-resolution images, with depth of field, clarity and colour contrast, and the surgeon uses special 3D glasses to improve his/her stereoscopic view (three-dimensional perception) and ability to observe specific ocular structures in greater detail.
The scope of digital visualisation
Dr García-Arumí believes that, “although current microscopes already provide excellent definition, the scope of digital images is much greater in this regard. We are now operating with 4k HD cameras, but soon we will be working with advanced 6k or 8k equipment, and so on.” When it comes to managing micron-sized ocular structures, this superior quality is very important in the opinion of the IMO retina specialist, who underlines the extra value provided by this innovation, particularly in the case of lesions affecting the macula (central part of the retina) which require a high degree of magnification.
Furthermore, he adds that, “thanks to the new 3D surgery systems, we can also obtain a better view of the periphery of the retina and avoid the deformation and glare produced by early models”. Another area in which digital technology has advanced is through a reduction in latency (i.e., offset time – the delay between the surgeon performing a manoeuvre until it appears on the screen) to within less than 0.1 s.
Dr Carlos Mateo, who also works at IMO’s Department of Retina and Vitreous, highlights the benefits offered by further on-screen information during surgery. “Although we are still in the early stages of 3D surgery and a lot of possibilities remain to be discovered, whilst viewing the patient’s eye we can also see other data of interest, such as endoscopic images, previous clinical tests, the machine’s parameters, etc., all for the purposes of perfecting our technique and ensuring the safest possible procedure.”
3D surgery is the future
3D systems are still evolving and Dr Mateo notes that, “many of their advantages are yet to come, both in terms of techniques to address vitreoretinal pathologies as well as cataracts or any other operation on the eye”. Therefore, the IMO specialist believes that, “the future of ophthalmological interventions is tied to 3D surgery, it will become a new standard that will change how we work in operating theatres”. At the moment, this technological innovation is catching the interest of increasingly more surgeons and it is a hot topic at international conferences, as pioneeringly demonstrated in 2015 by the German ophthalmologist Claus Eckardt who promoted 3D surgery at the IMO meeting Trends in Retina or as debated in the recent EURETINA 2017 congress held in Barcelona.
In this respect, 3D surgery not only represents a chance for experts to improve patient prognosis, but it also constitutes an opportunity for young ophthalmologists. According to Dr Mateo, “the ability to see exactly what the surgeon sees during the operation is extremely valuable in the context of teaching and can be used to help train and educate new generations in order to improve their command of different techniques”.
Beyond the clear advantages regarding the visualisation of and approach to operations, this new technology provides other benefits, such as ergonomic handling. In 3D surgery, which is also known as heads-up surgery, the surgeon does not have to tilt their head down towards the patient because they look directly at a screen, “once you get used to it, this change in position is much more comfortable”, add the IMO specialists.
New, state-of-the-art microscopes
IMO is a centre of reference in the application of new procedures and instruments, equipped with one of the most advanced surgical departments in Europe, not only insofar as patient hygiene, safety and comfort, but also in terms of technology and innovation. In addition to IMO’s commitment to 3D surgery, this month, two of their eight operating theatres have been fitted with the first ceiling-mounted microscopes in Spain – state-of-the-art Proveo 8 models featuring a sophisticated optical system, internal camera and high power LED light sources to increase the microscopic display capacity. What is more, as the equipment is installed on the operating room ceiling, the surgical team gains more room to manoeuvre and it reduces the risk of contamination.